Apertura, eficiencia, equidad y competencia l

Northern Africa: Algeria, Egypt, Libyan Arab Jamahiriya,

Morocco, Sudan, and Tunisia

Eastern Africa: Burundi, Comoros, Djibouti, Eritrea, Ethiopia,

Kenya, La Reunion (France), Madagascar, Malawi, Mauritius, Mozambique, Rwanda, Somalia, Tanzania, Uganda, Zambia, and Zimbabwe

Middle Africa: Angola, Cameroon, Central African Republic,

Chad, Democratic Republic of Congo, Republic of Congo, Equatorial Guinea, and Gabon

Southern Africa: Botswana, Lesotho, Namibia,

South African Republic, and Swaziland

Western Africa: Benin, Burkina Faso, Cape Verde,

Cote d’Ivoire, Gambia, Ghana, Guinea-Bissau, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, and Togo

Sub-Saharan Africa refers to the combined Eastern, Middle,

Stage at diagnosis: A majority of cancers in Africa are diagnosed at advanced stage of the disease because of lack of screening and early detection services, as well as limited awareness of early signs and symptoms of cancer among the public and health care providers. Stigma associated with a diagnosis of cancer also plays a role in late stage presentation in most parts of Africa. Survival: Survival after a diagnosis of cancer is much poorer in Africa than in the developed world for most cancer types (Table 10), especially those affected by screening and improved treatment. For example, the five-year survival rate for breast cancer is less

than 50% in Gambia, Uganda, and Algeria, compared to nearly 90% in the United States. In addition to being diagnosed at advanced stage of the disease, which limits treatment options, cancer patients in most parts of Africa have limited access to timely standard treatment, further diminishing their chance of survival. According to a World Health Organization (WHO) government survey of national capacity for cancer control programs in 2001, anti-cancer drugs were only available in 22% and affordable in 11% of the 39 African countries that participated in the survey.4

Figure 20. Estimated Numbers of New Cases and Deaths for Leading Cancer Sites in Africa and North America, 2008

Source: GLOBOCAN 2008.

Note: Estimated cases for Kaposi sarcoma are not available for all regions of Africa.

Africa Males

Females

Africa North America

North America

Estimated Cases

Prostate 39,500

Liver 34,600

Non-Hodgkin lymphoma 21,900 Lung & bronchus 20,800 Colon & rectum 19,000

Esophagus 17,500

Urinary bladder 16,900

Stomach 12,600

Leukemia 11,200

Oral cavity 8,400

All sites but skin 302,800

Estimated Deaths

Liver 33,800

Prostate 28,000

Lung & bronchus 19,400 Non-Hodgkin lymphoma 18,100

Esophagus 16,700

Colon & rectum 14,700

Stomach 11,900

Urinary bladder 11,400

Leukemia 10,600

Pancreas 4,600

All sites but skin 248,100

Estimated Cases Female breast 92,600 Cervix uteri 80,400

Liver 16,900

Colon & rectum 15,800 Non-Hodgkin lymphoma 15,300 Ovary 14,000 Esophagus 10,400 Stomach 10,100 Leukemia 8,300 Corpus uteri 7,400 All sites but skin 378,300

Estimated Deaths Cervix uteri 53,300 Female breast 50,000

Liver 16,600

Non-Hodgkin lymphoma 12,700 Colon & rectum 12,300

Ovary 10,400

Esophagus 9,900

Stomach 9,500

Leukemia 7,800

Lung & bronchus 5,500 All sites but skin 264,300

Estimated Cases

Prostate 213,700

Lung & bronchus 125,900 Colon & rectum 91,800 Urinary bladder 54,500 Non-Hodgkin lymphoma 39,300 Melanoma of skin 38,000 Kidney 37,400 Leukemia 28,000 Pancreas 20,600 Oral cavity 17,200 All sites but skin 831,800

Estimated Deaths Lung & bronchus 101,200

Prostate 32,600

Colon & rectum 28,700

Pancreas 19,400 Leukemia 13,800 Liver 13,700 Esophagus 12,600 Non-Hodgkin lymphoma 11,400 Urinary bladder 11,300 Kidney 9,500

All sites but skin 332,500

Estimated Cases

Breast 205,500

Lung & bronchus 110,700 Colon & rectum 85,300 Corpus uteri 44,700 Non-Hodgkin lymphoma 34,000 Thyroid 31,500 Melanoma of skin 30,100 Ovary 23,900 Kidney 23,900 Leukemia 20,900

All sites but skin 772,100

Estimated Deaths Lung & bronchus 79,300

Breast 45,600

Colon & rectum 29,700

Pancreas 18,700 Ovary 17,200 Non-Hodgkin lymphoma 10,700 Leukemia 10,200 Corpus uteri 8,100 Liver 6,500

Brain, nervous system 6,400 All sites but skin 305,900

Table 10. Five-year Relative Survival for Select Sites and Countries for the Most Recent Year for Which Data Are Available

Colon & Rectum Lung Stomach Breast Cervix Ovary Year of

Diagnosis M&F M F M&F M&F F F F

Gambia 1993-1997 4.0 – – 20.0 3.0 12.0 22.0 –

Uganda (Kyadondo) 1993-1997 8.0 – – 0.0 0.0 46.0 13.0 9.0

Algeria (Setif) 1990-1994 – 11.4 30.6 – – 38.8 – –

United States 1990-1992 62.2 62.1 62.4 14.0 21.6 85.4 70.6 42.6 United States 1999-2006 66.6 66.9 66.3 16.4 26.7 89.9 71.1 45.3

Survival data for African countries are based on cases followed through 1999. US cases were followed through 2007.

Incidence and mortality: Although age-specific incidence rates (per 100,000 persons) for all cancers combined generally increase with age in both Africa and the economically developed world, rates are generally lower in Africa.147 _{For example, the incidence}

rates are higher in the United States than in Uganda except in the 5- to 9-year and 30- to 40-year age groups in which rates are slightly higher in Uganda (Figure 21). The high incidence rates for ages 5-9 in the Uganda registry may reflect the high burden of non-Hodgkin lymphoma (especially Burkitt’s lymphoma) that accounts for about 50% of the overall cancer rates at this age interval.147 _{The elevated rates for ages 30-40 may reflect the early}

onsets of cervical cancer in women and liver cancer and Kaposi sarcoma in men.147-148

Compared to North America, the age-standardized incidence rate (per 100,000) for all cancers combined in Africa is about one-third as high for males (108.1 vs. 334.0) and less than half as high for females (115.3 vs. 274.4).2 _{This contrasts sharply with the}

relatively small differences in the overall age-standardized cancer death rates between the two regions for both males (122.4 in North America, 90.6 in Africa) and females (91.5 vs. 84.1).2 _The

high mortality rates relative to the incidence rates in Africa (Figure 22) show poor survival of cancer patients due to late stage

at diagnosis and lack of timely and standard treatment, as well as a higher proportion of more fatal cancers such as esophagus and liver.

Regional Differences in Cancer Rates in Africa